FRCR 2B Examiners' Report: Rapid Reporting

This article is transcribed from a webinar hosted by Dr. Koshy Jacob. We recommend this article for radiology students preparing to sit their FRCR 2B exam.

It can be quite confusing to sit the FRCR 2B Exams because they have this reputation for being clinical Exams. This makes them different from the Part 2A Exams which are primarily knowledge-based. Often, our members are overwhelmed when they start their preparation.

In this newsletter, I have looked at the Examiners' reports after each FRCR 2B Examination. The reports have succinct explanations of candidates' mistakes in each part. I have summarised their observations and put them together as tips for the Exam. I recommend you read these before you begin your revision.

Rapid Reporting

• The most important thing with rapid reporting is to ensure you completely and accurately identify abnormalities.
• Normal variants that cause symptoms will not be included as abnormalities (like accessory navicular, supracondylar spur, etc) but if you do get normal variants, you must mark them normal.
• Similarly, minor changes due to degenerative arthritis should be regarded as normal.

I think a lot of candidates get messed up because they over-call.

This is the most common kind of mistake that people make, and they over-call because they look at every line and they mention it.

Or they under-call, which is that you really haven't done enough Radiology. That's why you under-call.

• Now, it's very important that you identify whether a fracture is pathological. For example, if you have a fracture through a bone cyst, you've got to identify the abnormality as 'fracture through a bone cyst.' Just saying fracture is not enough. If it's pathological, you need to mention that.
• It's critical to describe the anatomical position of an identified fracture. So, you've got to say something like fracture base or transverse fracture base or fifth metatarsal.
• Identify all the fractures in a well-recognised fracture complex. So, if you see Holly's fracture, for example, please mention the fractures in it and where a second fracture would be expected.
• Plain images should be zoomed to get the best spatial resolution.
• It is important to distinguish between unilateral and bilateral facet dislocation, fracture-dislocations and isolated fractures.
• Do not note only one fracture in paired bones which normally fracture together, like radius and ulna, tibia and fibula.
• Do note only one fracture in a ring structure, like the pelvis or the mandible.
• Candidates are often poor in the interpretation of cervical spine radiographs. Even where they have identified an abnormality, they frequently mis-classify it. So, you would do well to look at many spine fractures and facet dislocations, facet fractures. Get used to doing them.

Marking

If the examiner is not certain that you've picked up the correct abnormality, they'll give you zero.

If you say something like lucent line, it's zero, you get no marks. If you say fracture through metatarsal, zero.

If you say fracture fifth metatarsal, you'll get half a mark. If you say fracture metatarsal base, but you don't say which toe it is, again, half a mark. And so, for a full mark, you either have to say transverse fracture base fifth metatarsal, but even fracture base fifth metatarsal will do. Just to be sure, add the side as well.

It pays to add the side. So just get used to every answer saying fracture base fifth metatarsal, left or left fifth metatarsal. And then you've covered.

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